Veterans Affairs is embroiled in an existential crisis, and Congress is faced with the aftermath of a scandal that grows worse by the day. Task & Purpose’s Stephen Carlson sat down with the chairman of the House Committee on Veterans Affairs, Florida Republican Congressman Jeff Miller, to discuss deception, bureaucratic incompetence and where the VA needs to go from here.

You have been chairman of the House Committee on Veterans Affairs since 2011. You have been in Congress since 2001. What do you think the single greatest challenge the new VA Secretary will face whenever he or she might be confirmed?

Changing the culture inside the agency. It doesn't matter what type of legislation is passed, what requirements are put in place, if the culture remains one of deceit and deception, which has become the watchword for VA over the recent months, nothing will change. That’s unfortunate, because the vast majority of the people at VA are working hard every day doing the job they should be doing, that the taxpayers expect them to do, and more importantly, the veterans. All of those people are being tainted by those within the system who choose to game it for their own personal benefit.

There are so many veterans today who use the phrase “delay ‘til they die,” nobody wants to believe that that is the case, but I can see why the perception is there because it takes so long to go through the process of disability ratings, getting into the system to get the health care. I believe we will be talking about the disability backlog again by the end of the year. They claim they have cut it by 50% with a 90% accuracy rating — that just is not true. As we focus on this, we continue to look at other issues too.

Do you have any particular choices for who should be the next secretary? Should it be a veteran or from the private sector?

I think it has to be somebody with the will to change the paradigm of the system that has been allowed to grow for decades. I've told people before that Secretary Shinseki would sit in the same spot you are, and I would tell him, “Mr. Secretary, these people are not telling you the truth. They are changing the numbers”, and he chose to believe the people that are changing the numbers, and he’s gone and they’re still there. He didn't even have the authority to fire those people. They still don’t have that authority. Some of these people should have been fired out of the box.

That being said, on the secretary side, that is a presidential decision, and I’m sure a whole mound of names will be lifted up to him. I hope it is somebody who can bring outside experience to the agency. That’s why I think Sloan Gibson is doing a good job as he does two things: He tries to get his head around the agency as a whole, but also trying to solve the problems that exist inside the VA. He comes from a corporate background, albeit banking, but just because they have done something the same way for 30 or 40 years does not apply today. That’s what happens inside the federal government, people get very comfortable.

As we've said, you've been chairman since 2011. When did it first come to your attention how severe the problems were, when you became chairman or well before?

Well, there were IG reports, GAO reports. Our committee has held hearings over several years, but as I became chairman and had the ability to use committee resources to dig deeper into what was going on, we actually asked for the GAO report everyone has been focusing on back in 2012, and in fact I was the lead requester of that report because we began to believe that it was much broader than what we were being told.

Until Sam Foote came forward and actually was able to provide us internal information and documents that were outside of the agencies internal reviews, you know, because I don’t believe GAO or IG had an idea that it was this systemic. I believe some people believed it was isolated, the secretary believed it was an isolated incident. I knew different. We knew it was systemic. The unfortunate thing is, you know that whistleblower that came out the other day on CNN, she says it’s still going on.

Yeah, like in the last couple of weeks. It seems kind of brazen, considering the spotlight they have been getting.

There are a lot of people who are circling the wagons to protect their jobs, and to stay out of criminal charges. Because I believe if DOJ does their job, they can reach no other conclusion than people cooked the books for personal financial gain.

I know you have called the Justice Department to investigate possible criminal charges and prosecute if it’s found, but have you referred anything in particular to them, or is that outside your purview?

No, I have not, the committee has not. We’d be glad to give you a copy of the letter we wrote, I don’t know if we even got a response beyond “We got your letter,” but of course everyone now knows that they are, you know, the director has said we are moving forward.

In Phoenix, correct?

Yeah, in Phoenix right now, but I believe they will go where the facts take them, and it will go beyond Phoenix. I’ve tried not to put the committee in a position where we are seen as using it as a political wedge against the president and the administration. I believe at this point that the FBI will be able to follow the leads out there because their numerous. Should we find they are not moving forward in the direction that they should, I’m sure we can make that information available to them. All of our information is public information, anyway.

You have accused VA officials of perjuring themselves. How high do you think the criminal charges will go in the end?

It’s hard to speculate, because there are several issues that need to be resolved. Number one is the veterans out there that need health care, it’s a crisis situation. Number two, we have to get the backlog erased. Number three is that we have to find the people that caused this and hold them accountable.

As far as the charges, I don’t want to speculate where they may go, because it may be perjury, because there have been people that have testified in Congress who knew differently, and then again the criminal charge of corruption within the federal government, for lying to Congress, all will play out over time. At this point I don’t want to speculate.

I want folks held accountable. Access and accountability are the two main thrust of the conference committee that met for the first time yesterday, in an attempt to again, that the doors are open at the VA for veterans, if they can’t get care there, they can get non-VA care, and number two that those responsible are held accountable. The sorry thing about the way VA’s culture has evolved is that even when somebody has done the wrong thing inside the system, VA won’t hold them accountable, they just move them.

I've heard stories of “Oh, we held them accountable by removing their title,” or “We've held them accountable by putting a temporary letter of reprimand in their file,” but it goes away in six months, or “We held them accountable by transferring them somewhere else.”

No. You hold them accountable by firing them and the problem is they can’t fire them because of the protections that are there and we have to find a way to allow the secretary to be allowed to make the decisions that are necessary to get things moving in the right direction in serving veterans.

Former Secretary of Defense Bob Gates said Congress is one of the principle culprits in the VA’s failure to provide care, and Sen. Coburn’s report released on Monday seemed to agree. They both accuse Congress of micromanagement and lack of oversight on the follow through. Do you agree that Congress and the committee bears a lot of responsibility?

There is plenty of blame to go around. I've said if blaming me solely will fix the problems at VA, blame me. Our committee, if you look at the Coburn report, according to his report, we've held 72 hearings to the Senate’s 20 hearings, 50 of ours are oversight hearings — we have been doing the oversight responsibility that we have been charged with.

Here’s what happens, though. We ask the GAO to make a report, they come out with their report and within it are recommendations. The VA then accepts those recommendations, we ask for a brief from the VA as to whether or not they have in fact implemented those recommendations, and they tell us yes. Okay, and then they lie about the numbers and outcomes, so it’s very difficult to get to the truth if you have an agency in the executive office that won’t be honest with you about where they are. That is why we have said we will dig in every corner that we can, we will get information in any way we can, to hold the VA accountable.

But again, we’re going back to the Coburn report that it’s clear which body has been doing oversight. It’s the House in the 113th Congress. I don’t know even know if the Senate has had any hearings since the ninth, we’ll need to look. To my knowledge, they didn't even have a hearing on Sanders’ big bill. That went straight to the floor — comprising maybe 85% of the bill was House-passed legislation that we have already passed. We have 12 bills sitting over there today if they would just take them up and vote on them.

I understand it is still in conference.

That is, but within that, the clinic bill, we have 27 clinics sitting in the House bill over there, and they could pick it up today and they would pass it. The in-state tuition bill is sitting over there, they could pick it up and pass it. But if these are things that Sanders believes are emergency pieces of legislation, I don’t know if the in-state tuition bill is what you would consider emergency. I support it because we passed it months ago in the House, but they could just take it up and move it forward and not have it bottled up in conference that is taking place right now.

That would be a problem. Over the last few years, we've seen scandals over GI Bill processing times, disability rating processing times, and now over the last month, we've seen the wait list scandals that led to preventable deaths. Do you think the VA system can survive in its current form, or does it need a total overhaul of the entire organization?

There has to be a major overhaul of the way they do business because typically what happens is that you have 21 medical districts out there, there is no need to have that many health networks out there, you have 23 VISNs , and all they have done over the last couple years is add to the VA mid-level bureaucracy that has moved people in the VHA, the people that deliver healthcare to the veteran further away from the leadership. There is 12 or 13 layers between the secretary and the doctor. That is no way to manage. Unfortunately, the dollars that have been spent at VA in recent times have been used to inflate middle management.

Anything you want to add?

A lot of people say throw more money at the system, throw more people at the system, and I say that is no way to get a solution. The VA, and especially the VHA, have more money than they can spend in a years’ time. It has been that way for several years, and they will carry that over, and that number will get added to the baseline budget next year. They say they need more doctors. No, what they need is to let the doctors see more people.

Dr. Lynch in last night’s hearing said each physician has a panel of maybe 1,200 patients that they see, and the average private physician has one twice that many. The VA docs see 8 to 10 patients a day, private physicians see maybe 20-plus patients a day, and their excuse is we don’t have the personnel and we don’t have the space. Well, yeah, you do have the space, the problem is that you don’t manage it well, and number two, if it’s a problem with not having the personnel, find people within a 330,000 personnel bureaucracy to take things away from the doctors that in the private sector are done by clerks! Don’t take a $300,000 employee and make him sit there on a computer for 90% of the time they are in there with a patient doing busy work. It doesn't serve the veteran well, and it’s not a good example of management of tax dollars. I have said this, too, that if money were the solution to the problems that exist today, this problem would have been fixed a long time ago.

Stephen Carlson served two tours in Afghanistan as an infantryman with the 10th Mountain Division. He lives in Washington, D.C. Follow him on Twitter.